恶性肠梗阻患者的代谢紊乱

罗贵娟; 缪明永

doi:10.16689/j.cnki.cn11-9349/r.2020.03.004

PDF(744 KB)

肿瘤代谢与营养电子杂志 ›› 2020, Vol. 7 ›› Issue (3) : 267-271. DOI: 10.16689/j.cnki.cn11-9349/r.2020.03.004

专家论坛

恶性肠梗阻患者的代谢紊乱

罗贵娟1，缪明永2

作者信息 +

Metabolic disorder in MBO

Luo Guijuan1, Miao Mingyong2

Author information +

文章历史 +

摘要

恶性肠梗阻是由恶性肿瘤引起的小肠或大肠梗阻，常见于卵巢癌及胃肠道肿瘤患者。恶性肠梗阻是由于肿瘤压迫、肿瘤细胞浸润自主神经、副肿瘤综合征或药物因素导致的急性或慢性肠道梗阻，是晚期肿瘤患者常见的致死性并发症之一。本文综合国内外进展探讨恶性肠梗阻患者的代谢紊乱情况及其机制，得出以下提示:恶性肠梗阻不仅引起葡萄糖、蛋白质、脂肪酸等宏量营养素的代谢紊乱，还会引起微量营养素代谢异常等。造成代谢紊乱的机制主要有肠道功能紊乱，肠道局部甚至全身发生炎性反应，肠道菌群紊乱及缺乏有效的营养治疗等因素。恶性肠梗阻患者发生代谢紊乱可能加剧肠梗阻的发展，更与患者的预后显著相关。临床决策中医生应重视患者的代谢情况，认识到代谢紊乱对恶性肠梗阻患者预后的影响，积极纠正代谢紊乱，提高患者的预后及生活质量。

Abstract

Malignant bowel obstruction is malignant tumor associated intestinal obstruction common in patients with advanced ovarian cancer or gastrointestinal cancer. It’s one of the most lethal complications caused by tumor compression, tumor cell infiltration of autonomic nerves, paraneoplastic syndrome, or drug related factors. In this review, we delineate the current studies on metabolic disorders and mechanisms of malignant bowel obstruction at home and abroad and draw the following conclusions. Malignant bowel obstruction not only causes metabolic disorders of macronutrients such as glucose, protein, and fatty acids, but also causes micronutrients disorders. Intestinal dysfunction, inflammation and intestinal flora disorders, and lack of effective nutrition support contribute to the occurrence of malignant bowel obstruction. Metabolic disorders could aggravate obstruction and closely related to the prognosis. Clinical decision-making should pay attention to the metabolic situation. Recognizing the significant influence on the prognosis of patients, doctors should take active treatment to the metabolic disorder and improve quality of life.

Key words

Malignant bowel obstruction｜Macronutrients metabolic disorders｜Micronutrients metabolic disorders｜Inflammation｜Intestinal flora disorders / Nutritional support

引用本文

EndNote

Ris (Procite)

Bibtex

导出引用

罗贵娟，缪明永. 恶性肠梗阻患者的代谢紊乱[J]. 肿瘤代谢与营养电子杂志. 2020, 7(3): 267-271 https://doi.org/10.16689/j.cnki.cn11-9349/r.2020.03.004

Luo Guijuan, Miao Mingyong. Metabolic disorder in MBO[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2020, 7(3): 267-271 https://doi.org/10.16689/j.cnki.cn11-9349/r.2020.03.004

参考文献

1.KEELEY J A, KAJI A, KIM D Y, et al. Predictors of ischemic bowel in patients with incarcerated hernias［J］. Hernia, 2019, 23(2):277-280.
2.GADDUCCI A, COSIO S, FANUCCHI A, et al. Malnutrition and cachexia in ovarian cancer patients: pathophysiology and management［J］. Anticancer Res, 2001, 21(4B):2941-2947.
3.RIGAUD D, HASSID J, MEULEMANS A, et al. A paradoxical increase in resting energy expenditure in malnourished patients near death: the king penguin syndrome［J］. Am J Clin Nutr, 2000, 72(2):355-360.
4.SECOR S M, CAREY H V. Integrative physiology of fasting［J］. Compr Physiol, 2016, 6:773-825.
5.付海军.肠梗阻时代谢变化和液体治疗探讨［J］.亚太传统医药, 2011, 7(7):129-130.
6.刘放南,谭力,罗楠,等.高效液相色谱法测定血清瓜氨酸与国人正常值［J］.肠外与肠内营养, 2004,11(2):116-117.
7.HYPLER R, TICH A, KAKA M, et al. Markers of perioperative bowel complications in colorectal surgery patients［J］. Dis Markers, 2015, 2015:428535.
8.RUAN P, GONG Z, ZHANG Q. Changes in plasma D (-)-lactate, diamine oxidase and endotoxin in patients with liver cirrhosis［J］. Hepatob Pancreat Dis, 2004, 3(1):58-61.
9.JUEL I S, SOLLIGRD E, SKOGVOLL E, et al. Lactate and glycerol released to the intestinal lumen reflect mucosal injury and permeability changes caused by strangulation obstruction［J］. Eur Surg Res, 2007, 39(6):340-349.
10.PRRAGA ROS E, CORREA-MARTN L, SNCHEZ-MARGALLO F M, et al. Time-course evaluation of intestinal structural disorders in a porcine model of intra-abdominal hypertension by mechanical intestinal obstruction［J］. PLoS One, 2018, 13(1):e0191420.
11.ROELAND E, VON GUNTEN C F. Current concepts in malignant bowel obstruction management［J］. Curr Oncol Rep, 2009, 11(4):298-303.
12.WANGENSTEEN O H. Understanding the bowel obstruction problem［J］. Am J Surg. 1978；135(2):131-149.
13.MCCAFFREY J F. Metabolic acidosis in acute intestinal obstruction［J］. Aust N Z J Surg. 1966；36(2):111-115.
14.WARD J B, KEELY S J, KEELY S J. Oxygen in the regulation of intestinal epithelial transport［J］. J Physiol, 2014, 592(12):2473-2489.
15.史长法,王佳.绞窄性肠梗阻术前电解质改变与治疗［J］. 泸州医学院学报, 1989, (6):462-463.
16.SCRIPKO V D, KOVALENKO A L, ZAPLUTONOV V A. Microelemental homeostasis correction of and oxidative stress in patients with acute intestinal obstruction［J］. Khirurgiia (Mosk), 2017, (6):55-59.
17.PERRI T, KORACH J, BEN-BARUCH G, et al. Bowel obstruction in recurrent gynecologic malignancies: defining who will benefit from surgical intervention［J］. Eur J Surg Oncol, 2014, 40(7):899-904.
18.HENRY JC, POULY S, SULLIVAN R, et al. A scoring system for the prognosis and treatment of malignant bowel obstruction［J］. Surgery, 2012, 152(4):747-757.
19.张传宝,张敬坡,冯雷,等.肠、肝脂肪酸结合蛋白在肠梗阻诊断中的意义［J］.山西医科大学学报, 2016, 47(7):608-610.
20.CONNOR F L, DI LORENZO C. Chronic intestinal pseudo-obstruction: assessment and management［J］. Gastroenterology, 2006, 130: S29-S36.
21.ZHOU H, YU B, GAO J, et al. Regulation of intestinal health by branched-chain amino acids［J］. Anim Sci J, 2018, 89(1):3-11.
22.THAZHATH S S, WU T, YOUNG R L, et al. Glucose absorption in small intestinal diseases［J］. Expert Rev Gastroenterol Hepatol, 2014, 8(3):301-312.
23.ZHANG J, CHI H, XIAO H, et al. Interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) single nucleotide polymorphisms (SNPs), inflammation and metabolism in gestational diabetes mellitus in inner mongolia［J］. Med Sci Monit, 2017, 23:4149-4157.
24.NELLGRD P, CASSUTO J. Inflammation as a major cause of fluid losses in small-bowel obstruction［J］. Scand J Gastroenterol. 1993；28(12):1035-1041.
25.DE WINTER B Y. Study of the pathogenesis of paralytic ileus in animal models of experimentally induced postoperative and septic ileus［J］. Verh K Acad Geneeskd Belg, 2003, 65(5):293-324.
26.LU R H, CHANG T M, YEN M H, et al. Involvement of superoxide anion in the pathogenesis of simple mechanical intestinal obstruction［J］. J Surg Res, 2003, 115(2):184-190.
27.FIROOZMAND E, FAIRMAN N, SKLAR J, et al. Intravenous interleukin-6 levels predict need for laparotomy in patients with bowel obstruction［J］. Am Surg, 2001, 67(12):1145-1149.
28.CALVO-RODRGUEZ R, MONTERO-PREZ F J, GARCA-OLID A, et al. Value of plasma C-reactive protein and lactate dehydrogenase levels in the diagnosis of intestinal obstruction in an emergency department［J］. An Sist Sanit Navar, 2016, 39(1):115-122.
29.ETO S, KAWAHARA H, MATSUMOTO T, et al. Preoperative neutrophil-lymphocyte ratio is a predictor of bowel obstruction due to colorectal cancer growth［J］. Anticancer Res, 2019, 39(6):3185-3189.
30.朱鹏程, 梁中林,王光辉,等.血浆降钙素原对结直肠癌术后肠梗阻中的预测作用［J］.中国普通外科杂志, 2013, 22(10):1319-1323.
31.ZHU B, WANG X, LI L. Human gut microbiome: the second genome of human body［J］. Protein Cell, 2010, 1(8):718-725.
32.COSTA R I D D, RASSLAN R, KOIKE M K, et al. Bacterial translocation and mortality on rat model of intestinal ischemia and obstruction［J］. Acta Cir Bras, 2017, 32(8):641-647.
33.FUKUSHIMA T, KAWAMOTO M, ISHIGURO N, et al. Short chain fatty acid in intestinal obstruction［J］. Jpn J Surg. 1983；13(2):117-121.
34.HEGDE S, LIN YM, GOLOVKO G, et al. Microbiota dysbiosis and its pathophysiological significance in bowel obstruction［J］. Sci Rep, 2018, 8(1):13044.
35.LIN YM, FU Y, HEGDE S, et al. Microsomal prostaglandin E Synthase-1 plays a critical role in long-term motility dysfunction after bowel obstruction［J］. Sci Rep, 2018, 8(1):8831.
36.WONG PW, ENRIQUEZ A, BARRERA R. Nutritional support in critically ill patients with cancer［J］. Crit Care Clin, 2001, 17: 743-767.
37.GALLARDO-VALVERDE J M, CALAAS-CONTINENTE A, BAENA-DELGADO E, et al. Obstruction in patients with colorectal cancer increases morbidity and mortality in association with altered nutritional status［J］. Nutr Cancer, 2005, 53(2):169-176.
38.BOZZETTI F. The role of parenteral nutrition in patients with malignant bowel obstruction［J］. Support Care Cancer, 2019, 27(12):4393-4399.
39.杨光. 新辅助化疗+营养干预对结肠癌不全性肠梗阻患者营养状况、肿瘤负荷的影响［J］. 临床医药文献电子杂志, 2019, 6(57):63-65.
40.CHANG T, LU R, TSAI L. Glutamine ameliorates mechanical obstruction-induced intestinal injury［J］. J Surg Res, 2001, 95(2):133-140.
41.BATISTA M A, NICOLI J R, MARTINS FDOS S, et al. Pretreatment with citrulline improves gut barrier after intestinal obstruction in mice［J］. JPEN J Parenter Enteral Nutr, 2012, 36(1):69-76.
42.QUIRINO I E, CORREIA M I, CARDOSO V N. The impact of arginine on bacterial translocation in an intestinal obstruction model in rats［J］. Clin Nutr, 2007, 26(3):335-340.